Individual
MARY LISA MICHAEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, OTR
Contact information
Practice address
28100 TORCH PARKWAY, SUITE 600, WEST LAFAYETTE, IN 47906
(765) 427-6171
Mailing address
60 LANE 160 JIMMERSON LK, ANGOLA, IN 46703-9178
(260) 243-0816
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31001433A
IN
Other
Enumeration date
07/13/2021
Last updated
07/13/2021
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